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Upstate provides advanced care for severe frostbite

Ice Hanging from Pine NeedlesPeople who suffer severe frostbite often face amputation, but an interventional radiologist at Upstate offers specialized treatment that could change that. Dianbo Zhang MD uses the drug, tPA (tissue plasminogen activator) to dissolve blood clots and restore circulation to limbs that have frozen.

He says patients have a significantly better chance of avoiding amputation when trans-arterial thrombolysis is administered within 24 hours. A study of severe frostbite patients in Utah showed 41 percent who did not receive tPA lost fingers, hands, toes or feet. Only 10 percent who received tPA underwent amputations.

Zhang inserts a catheter into the femoral artery in the patient‘s groin and injects a dye that, combined with Xray, allows him to see blockages. The medication is directed to the area of injury and administered over 12 to 24 hours. Since tPA carries with it the risk of internal bleeding, certain patients with blood disorders are not candidates for this treatment.

Central New Yorkers are most familiar with stage 1 frostbite, known as frostnip. It‘s when we stay outside for too long and our fingers start burning or tingling. We go inside, remove our gloves, and our pale fingers turn red as we warm up.

People with stage 2 frostbite temporarily lose some sensation as their skin freezes and blisters form.

Dianbo Zhang MDIf deep tissue is affected, frostbite is classified as stage 3 or 4. Blisters that form fill with blood, and people lose the ability to feel their fingers. These are the patients Zhang is poised to help with tPA. Some damage from severe cases of frostbite cannot be reversed, but even in those instances Zhang says he may be able to reduce the amount of tissue that must be amputated.

Zhang joined Upstate after completing fellowships at Massachusetts General/Harvard University and Brigham and Women‘s Hospital in Boston.

Read the abstract for the study about severe frostbite in the Archives of Surgery